Duct In Man Research Articles

Morphological and morphometrical study of the nasal opening of nasolacrimal duct in man.

Epiphora constitutes one of the major and very common problems in all age groups. Recent developments in ophthalmology such as balloon dilatation, stent implantation, laser therapy and endoscopy of the lacrimal drainage system raise the need for a detailed anatomical knowledge of this system. It is also important for formulation of principles and techniques in the management of acrimal problems. The aim of this study was to demonstrate variations in shape, size and location of the opening of the nasolacrimal duct and of the lacrimal fold. Twenty sagittal head sections were obtained, the nasal septum was removed and the lateral wall of the nasal cavity was exposed and examined. The opening of the nasolacrimal duct (NLD) was demonstrated and was subjected to anatomical observations for the shape, site, size, opening type and the presence of the lacrimal fold. The different measurements for the distances between the opening of NLD and anterior nasal spine, palate and inferior concha were made. The examined specimens showed that the opening of the NLD was variable in shape taking the form of sulcus in 70% and fissure in 30% of specimens. The sulcus was either vertical or oblique while the fissure was either vertical, oblique or in the form of anteroposterior one. Regarding the location, the opening of the NLD was located at anterior one third below line of attachment of the inferiorconcha in nearly half of cases (45%). The lacrimal fold was present in most of examined specimens (70%) and absent in 30%. The fold take 5 different forms. The knowledge of the morphology and morphometry of the lacrimal drainage system enables the ophthalmologist to plan intervention on the lacrimal drainage system precisely and avoid unnecessary manipulations and also minimizing the risk of injury during intra-nasal surgery.

Phosphodiesterase 5 (PDE5) inhibition, ANP and NO rapidly reduce epididymal duct contractions, but long-term PDE5 inhibition in vivo does not

Contractility of the peritubular smooth muscle layer ensures the transit of immotile spermatozoa through the epididymal duct to acquire their fertilizing capacity. Atrial natriuretic peptide (ANP) and nitric oxide (NO) affect contractility via cGMP signals that are controlled by phosphodiesterases (PDEs). Sildenafil inhibits the cGMP-hydrolyzing PDE5 and thereby promotes relaxation of smooth muscle cells. While sildenafil is increasingly used in young patients for the treatment of pulmonary hypertension, virtually no knowledge exists about PDEs in the epididymis. Western blotting, immunohistochemistry and RT-PCR analyses after laser capture microdissection localized PDE5 to smooth muscle cells, but not to epithelial cells, of the epididymal duct in man and rat. Sildenafil, ANP and NO significantly slowed spontaneous contractions of rat epididymal duct segments in organ bath studies. Sildenafil effects were additive to ANP and NO. Long-term exposure to sildenafil in vivo did not change the PDE5 expression or the observed contractility pattern with the rapid relaxing response toward ANP, NO and sildenafil. Data demonstrate that PDE5 is an important member of cGMP signaling pathways regulating the finely orchestrated process of epididymal duct contractility and suggest, however, that in the epididymis side effects of therapeutically used sildenafil are unlikely.

Pressure measurements in the cervical portion of the thoracic duct in man.

Abstract Pressures were measured in the cervical portion of the thoracic duct during a surgical procedure performed to drain lymph in 8 male patients. Cyclic variations depending on respiration were observed. Smaller oscillations in pressure were synchronous with the pulse-rate and result from rhythmic compression of the thoracic duct by the aorta in the thorax. In 2 patients the recordings showed superimposed pressure waves which were independent of breathing and the heart-rate and which are thought to be due to spontaneous contractile activity of the duct.

A new look at the arterial supply of the bile duct in man and its surgical implications.

The blood supply of the human bile duct has been re-evaluated using high resolution resin casts prepared from 24 fresh human cadavers. The refined technique used yielded casts of all vessels, including capillaries, and produced a clear picture of the blood supply of the human bile duct for the first time. The arterial supply of the supraduodenal duct was shown to be axial, with the main vessels, which have been named the 3 o'clock and 9 o'clock arteries, running along the lateral borders. The retroportal artery, which has not been described by previous workers, was present in all complete casts and was a major source of the axial blood supply to the supraduodenal duct in 32 per cent of them. The major importance of this new knowledge of bile duct blood supply may well lie in the understanding of the aetiology of postoperative bile duct strictures and in their prevention. An explanation is proposed for the long strictures sometimes seen after minimal surgical trauma to the bile duct, based on damage to the small vessels supplying the duct; guidelines to prevent such damage are presented. Ischaemia of the bile duct may also explain some of the biliary problems that have followed human liver transplantation and other procedures involving biliary anastomosis, such as Whipple's operation.

Adaptive hepatic changes in mild stenosis of the common bile duct in the rat.

Adaptive hepatic changes were investigated in rats with mild stenosis of the common bile duct and in sham-operated controls. The studies were performed 24 h and 7-12 days postoperatively. A continuous intravenous infusion of taurocholic acid at stepwise-increasing rates was performed to explore the responses to bile acid effects. During the infusion, bile flow and the outputs of bile acids, phospholipids, cholesterol, alkaline phosphatase and gamma glutamyl transpeptidase were studied. At the end of the infusion, hepatic morphometric measurements were performed. In other experimental sets, biliary excretions of horseradish peroxidase, a marker of microtubule-dependent vesicular transport in the hepatocyte, and sulphobromophthalein, a well-known organic anion model, were studied. In other rats, bile acid pool size and composition were determined by depletion of bile. The results in rats with mild stenosis maintained for 24 h showed a greater susceptibility to the toxicity of taurocholic acid, as revealed by the abrupt decrement in bile flow at high rates of infusion, and increased outputs of phospholipids and canalicular enzymes. Conversely, rats with mild stenosis maintained for 7-12 days showed decreased bile acid maximum secretory rate and biliary outputs of phospholipids and canalicular enzymes, as well as hepatocyte hypertrophy. These findings may explain the limited hepatic and systemic repercussion of experimental mild stenosis of the common bile duct and help us to understand the early stages of constriction of the common bile duct in man.

Pancreatic secretion obtained by endoscopic cannulation of the main pancreatic duct and secretin release after duodenal acidification in man.

The main pancreatic duct was cannulated in 12 individuals with a teflon catheter by means of a side-viewing duodenscope. Six individuals received a duodenal infusion of 40 ml 100 mmol/l HCl over 5 min, while the other six served as controls for basal pancreatic secretion. Pancreatic juice was collected in 5-min samples, and blood was frequently drawn for radioimmunoassay of immunoreactive secretin (IRS). In the control group, during 20-min cannulation of the main pancreatic duct, no effect was seen on basal secretion of water, bicarbonate, or alpha-amylase--nor did the IRS levels change. After duodenal acidification there was a significant increase in IRS (p less than 0.02), reaching the highest level at 7 min. The mean flow rate, bicarbonate concentration, and bicarbonate output showed a significant increase as compared to the control group (p less than 0.02), the highest levels being reached in the third 5-min period after the start of the duodenal acidification. The alpha-amylase output was also significantly higher after acidification (p less than 0.02) than in the control group, but the mean alpha-amylase concentration decreased after acidification, reaching its nadir in the third 5-min sample (p less than 0.02). The present results demonstrate a basal and HCl-stimulated pancreatic secretion collected by endoscopic cannulation of the main pancreatic duct in man together with plasma IRS levels.

Abrasive Cytology of the Pancreatic and Biliary Duct in Man

Abrasive Cytology of the Pancreatic and Biliary Duct in Man

Cannulation of the Right Lymphatic Duct in Man

Cannulation of the right lymphatic duct was performed in 35 cases prior to thoracic surgery. Some comments are made about surgical anatomy and technique. Lymph flow proved to be greatest in patients with mitral valve disease and left ventricular aneurysm, somewhat less in aortic valve disease, and least in patients without manifest cardiac disease. Albumin content was low in combination with high flow of lymph. the concentrations of electrolytes (Na+, K+, Ca++, Cl−) and the enzyme activity (GOT, EC: 2. 6. 1. 1., CPK, EC: 2. 7. 3. 2., LDH, EC: 1. 1. 1. 27., GPT, EC: 2. 6. 1. 2.) in lymph and serum are presented and further discussed. the possibility of gaining information about cardiac metabolism by continuous lymph analyses is presented and outlined.

Efflux of Prostaglandin-like Smooth-Muscle-Stimulating Activity in the Right Lymphatic Duct in Man

Efflux of Prostaglandin-like Smooth-Muscle-Stimulating Activity in the Right Lymphatic Duct in Man

Efflux of Prostaglandin-like Smooth-Muscle-Stimulating Activity in the Right Lymphatic Duct in Man

The right lymphatic duct, draining mainly the heart and the lungs, was cannulated in 13 patients undergoing cardiac or pulmonary surgery and in one patient with pulmonary contusions. Lymph fluid was collected and examined for lipid soluble smooth-muscle-stimulating activity. Lipid fractions of lymph fluid from 8 patients were assayed for smooth-muscle-stimulating activity. Smooth-muscle-contracting activity, similar to that of PGE2, was recorded in 3 cases. Lymph from 3 patients evoked tachyphylaxis (the decreasing response which follows consecutive injections made at short intervals) or relaxation. In lymph from 2 patients no smooth-muscle-stimulating activity was detected. Lymph fluid from 5 patients was analysed by silicic acid chromatography in combination with smooth muscle assay. Prostaglandin-like material, mainly of the E-type, was detected in 4 cases. Biological inactivation of prostaglandin E2 was observed when this compound was incubated with lymph fluid. The results indicate that prostaglandin...

Thoracic duct lymph and lymphocyte studies in man using a thoracic duct "side-fistula".

A technique for cannulation of the cervical thoracic duct in man is described. It leaves the thoracic duct circulation unimpaired and allows repetitive lymph sampling without loss. This technique can be used to study the re-circulating pool of long-lived lymphocytes and thereby help to evaluate better the immunologic status of cancer patients. The technique of side-cannulation has been used in one patient. Thoracic duct lymphocytes labelled with 51Cr were reinfused IV and were recovered in the thoracic duct in a stable number over a 5-day study, thereby demonstrating a recirculating lymphocyte pool in man and the applicability of the side-cannulation to its study.

Structure of the common bile duct in man: presence or absence of smooth muscle.

MAHOUR, G. HOSSEIN M.D.; WAKIM, KHALIL G. M.D.; SOULE, EDWABD H. M.D.; FERRIS, DEWARD O. M.D. Author Information

The common bile duct in man: its diameter and circumference.

The common bile duct in man: its diameter and circumference.

Formation of the third branchial duct in man.

Formation of the third branchial duct in man.

Roentgenography of the thoracic duct in man by oral administration of contrast media.

SummaryX-ray views of the thoracic duct by means of orally administered contrast media have been obtained for the first time by providing for adequate emulsification and dispersion of an iodinated fat prior to administration.

Blood Lymphocyte Count Following the Ligation of the Thoracic Duct in Man

Blood Lymphocyte Count Following the Ligation of the Thoracic Duct in Man

The anatomy of the sphincter of Oddi

A three-dimensional reconstruction of the intrinsic musculature surrounding the end of the common bile duct in man, generally referred to as the sphincter of Oddi, is presented. Here is visualized grossly for the first time the structure of the muscles in this important region in the adult human. A separate circular sheath of muscle is seen which by contraction can cause the clinical picture known as biliary dyssynergia. The model substantiates in the main and visualizes in three dimensions the findings reported by Hendrickson, Nuboer, Schwegler and Boyden, and Kreilkamp and Boyden.

ENDOLYMPHATIC AND ASSOCIATED DUCTS IN MAN

HISTORICAL REVIEW Although numerous studies have dealt painstakingly with the nervous portions of the membranous labyrinth, few have been concerned with the structure of the non-nervous areas of the epithelial ducts. Consequently, little was known until recently about the endolymphatic duct in man. Two portions of the duct system have of late received attention, namely, the slitlike communication of the endolymphatic duct with the utricle and the rugose wall of the endolymphatic duct itself. In 1928 Bast¹first described the "cusp or valve" which in the human embryo "projects into the utriculus and guards the utricular opening into the utriculo-endolymphatic duct." Struck by its definiteness, Bast expressed the belief that so pronounced a structure must serve a function and suggested that "in case of any sudden pressure disturbance this valve may prevent the outflow of endolymph from the utricle, thus maintaining a more constant pressure within the

Observations Following Distension of the Gallbladder and Common Duct in Man

The susceptibility of the gallbladder and common duct to overdistension from various causes makes them a common source of visceral and referred pain. The location of pain in gallbladder disorders varies and there is nothing in its character to differentiate it from pain resulting from a change in the state of the common duct. Patients with biliary disease commonly complain of chronic indigestion and, in addition, their pain may be referred to the interscapular and infrascapular regions, right upper quadrant, epigastrium and occasionally to the left side. Various theories have been proposed to explain the mechanism of this “referred” visceral pain.1, 2 Our observations were made on six women operated upon for gallbladder disease. Their complaints varied from chronic indigestion to typical, as well as bizarre, radiation of the pain. Chronic cholecystitis and choleliathiasis were found in every case at operation. Method. In 4 patients the gallbladder was exposed and the stones removed after a short gas-oxygen anesthesia. A sterile rubber balloon, carried on a sterile hollow metal rod, was inserted into the gallbladder. The rod was connected to a blood pressure apparatus through which the balloon could be inflated and the amount of pressure recorded. The fundus of the gallbladder was then sealed around the rod by several sutures and the organ replaced in the abdomen. The edges of the wound were held in approximation and all gauze and retractors removed from its margins to avoid additional painful stimuli. The distension was carried out after the patient had recovered sufficiently from the short anesthesia to answer questions intelligently. In one patient the observations were made following exposure of the gallbladder under local infiltration anesthesia of the right upper quadrant.

THE EFFECT OF CHOLECYSTECTOMY ON GASTRIC SECRETION

It is generally stated that disease of the gallbladder is associated with changes in gastric secretion. Most observers (Holweg,1Rohde,2Leva3and Glaser,4and recently Gatewood5) have found that hypoacidity and anacidity are present in cases of cholelithiasis and that similar findings are present after cholecystectomy. Other observers,6however, have stated that hyperacidity and hypersecretion occur in cases of cholecystitis and in gallbladder disease associated with biliary retention. Thus Simnitsky7found hyperacidity in obstruction of the common duct in man and animals. These observations, particularly the alleged persistence of change in gastric secretion after cholecystectomy, led us to inquire into the relation of the gallbladder to the gastric secretory mechanism. Besides making a study of the effect of cholecystectomy on gastric secretion, we have studied the effect of bile on gastric secretion and have examined the mucosa of the gallbladder for the presence of a gastric secretin. PROCEDURE Pawlow pouches